Aprindine-induced polymorphous ventricular tachycardia

Scagliotti, Daniel; Strasberg, Boris; Hai, Hamid A.; Kehoe, Richard F.; Rosen, Kenneth M.

doi:10.1016/0002-9149(82)90059-5

Cited by 29 publications

(3 citation statements)

References 14 publications

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“…APD is reduced by a decrease in the tetrodotoxin-sensitive inward sodium current during the plateau phase of the AP. Aprindine lengthens ERP significantly in atrium and ventricle [195,239], which results in a significant QT prolongation and the occurrence of torsades de pointes [65,193,216]. Scagliotti [193] reported on five patients with torsades de pointes; their QT interval was >0.55 seconds and proarrhythmia was common with previous proarrhythmia during treatment with quinidine, disopyramide, or procainamide.…”

Section: Characteristics Of Proarrhythmia After Drug-lnduced Qt Prolomentioning

confidence: 99%

QT-Interval prolonging drugs: Mechanisms and clinical relevance of their arrhythmogenic hazards

Zehender

Hohnloser

Just

1991

Cardiovasc Drug Ther

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The antiarrhythmic principle of drug-induced QT-interval prolongation is well known. However, with the widespread use of the presently known and new Class III antiarrhythmic agents under investigation, and the growing number of agents not primarily designed as antiarrhythmic drugs that potentially cause QT prolongation, we have also become aware of the proarrhythmic hazards associated with many of these agents. The proarrhythmic risk differs markedly from one agent to another and interferes with many individual clinical variables (e.g., hypokalemia, sinus bradycardia). This paper summarizes the present data on the proarrhythmic risk of drug-induced QT prolongation, including the value and problems of the rate-corrected QT interval, the mechanisms involved in the genesis of proarrhythmia, and the clinical cofactors that facilitate the occurrence of proarrhythmic events. In addition, an extensive database provides information on the known proarrhythmic risk of all currently used QT-prolonging agents.

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Section: Characteristics Of Proarrhythmia After Drug-lnduced Qt Prolomentioning

confidence: 99%

QT-Interval prolonging drugs: Mechanisms and clinical relevance of their arrhythmogenic hazards

Zehender

Hohnloser

Just

1991

Cardiovasc Drug Ther

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“…Aprindine is a Class 1b antiarrhythmic agent, which is known to shorten the action potential. QT interval prolongation and polymorphous ventricular tachycardia have been reported as side effects of aprindine [ 10 ]. It is possible that preoperative oral aprindine and intraoperative desflurane may have affected the proarrhythmic effects of droperidol.…”

Section: Discussionmentioning

confidence: 99%

Delayed Ventricular Tachycardia After Prophylactic Doses of Droperidol in Patients With Mild QT Interval Prolongation Due to Preoperative Medication

Takechi¹,

Shimizu²

2021

Cureus

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Prophylactic doses of droperidol are effective in preventing postoperative nausea and vomiting (PONV). However, due to concerns of QT interval prolongation and ventricular arrhythmias, the safety of droperidol for PONV prophylaxis has been debated.A 70-year-old woman was scheduled for total knee arthroplasty. She had a history of aortic valve replacement. Oral aprindine (40 mg/day) was prescribed. Preoperative electrocardiogram showed mild QT interval prolongation (QTc = 475 ms). Anesthesia was induced using propofol, remifentanil, and rocuronium, and maintained using desflurane, remifentanil, and a bolus dose of rocuronium.The surgery was uneventful. At the time of skin closure, droperidol (1.25 mg) was administered intravenously for PONV prophylaxis. Twenty-three minutes after administration of droperidol, a sudden onset of premature cardiac contraction was observed, which progressed directly to ventricular tachycardia and atrioventricular block. Arrhythmia due to droperidol-induced QT interval prolongation was strongly suspected. Intravenous magnesium sulfate (2 g) and atropine (0.5 mg) were administered immediately. The ventricular tachycardia resolved quickly after the magnesium injection. Following the resolution of the arrhythmia, the patient was extubated.The patient experienced ventricular tachycardia after a prophylactic dose of droperidol that resulted from QT interval prolongation due to the preoperative medication. It may be prudent to avoid even low-dose droperidol in the background of already present QT prolongation, especially when multiple putative QTprolonging drugs are used.

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“…Gastrointestinal dis comfort, cholestatic jaundice, and agranulocy tosis arc other side effects limiting the drug's availability. Aprindine has also been reported to cause spontaneous arrhythmias [52], Be cause of the problems with drug toxicity, Eli Lilly & Co. is developing an aprindine deriv ative. Indecainide, that has fewer side effects and is six times more potent than dispyramide.…”

Section: Aprindinementioning

confidence: 99%

Antiarrhythmic Drug Therapy

Somberg¹

1985

Cardiology

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A number of conventional and newer antiarrhythmic agents are available for the treatment and prophylaxis of ventricular tachycardia and sudden death. Using a multifaceted approach of programmed electrical stimulation studies, drug level determinations, exercise tolerance testing, and 24-hour ambulatory electrocardiographic monitoring, the physician can identify those patients who require therapy and then predict the likelihood of efficacy with each antiarrhythmic agent. This approach affords evaluation of both aspects of the sudden death equation-ectopy frequency (triggering mechanism) and vulnerability to development of sustained ventricular tachycardia (substrate). After institution of therapy, careful follow-up is necessary to document sustained drug efficacy and detect side effects. Serious adverse reactions necessitate a change in antiarrhythmic therapy, as opposed to lowering drug dosage to an ineffective level. The unacceptably high incidence of sudden death due to electrical instability can be reversed only by a rigorous and dedicated long-term approach to the management of serious ventricular arrhythmias.

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Aprindine-induced polymorphous ventricular tachycardia

Cited by 29 publications

References 14 publications

QT-Interval prolonging drugs: Mechanisms and clinical relevance of their arrhythmogenic hazards

QT-Interval prolonging drugs: Mechanisms and clinical relevance of their arrhythmogenic hazards

Delayed Ventricular Tachycardia After Prophylactic Doses of Droperidol in Patients With Mild QT Interval Prolongation Due to Preoperative Medication

Antiarrhythmic Drug Therapy

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